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Monday, January 15, 2018

How can we ensure that the global south benefits from and contributes to the field of bioethics?

There has been a legitimate debate going on for many years
about the question of how we can ensure that colleagues in the global south can
both benefit from bioethics journals such as this, as well as contribute constructively
to them.

The issue of access to subscription- based journals has been
litigated ad nauseam and I do think global publishers have done by and large a
decent job in terms of implementing with WHO and other agencies myriad access
themes available to those countries too resource- constrained to afford regular
subscriptions.[1]

Some authors disagree, insisting that only Open Access
journals, a supposedly superior business model, can address the access problem
adequately. And they are right, Open Access journals, by definition, pose no
access problems of the kind subscription- based journals pose. Sadly, having
your cake and eating it too rarely works in the real world, and so these
authors, having resolved the access to academic research problem, are faced
with a different problem they did not have before. Open Access journals can
only survive as viable enterprises if a sufficiently high number of authors pay
what are often expensive article processing charges, or APCs. These journals
often offer their equivalent to the access schemes subscription- based journals
have put in place, namely differential fees or fee waivers for those who
absolutely cannot afford to pay.

Short of asking academics to exploit themselves by
volunteering to produce and disseminate academic journals and their content,
reliably, over decades, someone will
have to pay for the resource intensive production of journals and to ensure the
reliable availability of their content.

I have yet to see from those complaining about access
problems realistic solutions to this
challenge. They mostly, and typically correctly identify the problem, but
beyond grandstanding they offer no answers. They expect someone else to sort things out for them.

As I said, authors in the global south can access bioethics journal content either by means of the access schemes mentioned earlier, or by simply
emailing the authors of content they are interested in and by asking those
authors for a complimentary electronic copy of their article. Nobody would
decline such a request.

I do think that a much greater challenge is to enable
scholars from the global south to participate in international conferences and
workshops both to share their own knowledge, but also to learn from colleagues
and to network with a view to establishing research partnerships and the like.

I suspect you will know Facebook. I posted a photo from a
workshop I had organised in the summer of 2017 in the UK, on the most recent
version of the Council for International Organizations of Medical Sciences (CIOMS) research ethics guidelines. Not
unexpectedly a colleague, located in an upmarket London- based university,
harangued me for the lack of diversity, perhaps most significantly, the evident
lack of attendees from the global south. That colleague was right: only two of
the 25 or so workshop delegates came from the Caribbean, while everyone else
came from countries of the global north. Of course, I had virtually no funding
to organise said workshop, and everyone who travelled there paid their own way.
Nobody’s flight was covered by me. I did have inquiries from various colleagues
in the global south who would have loved to attend, but quickly gave up on the
idea due to lack of funds for their travel expenses. The colleague who criticized
me quite publicly, naturally, had no funds to offer either. It is always easier
to criticize than to contribute meaningfully to change. The same, as I tried to
show, holds true for academics who refuse to acknowledge the cost involved in
producing academic journals.

Some constructive attempts have been made to have a more
globally representative group of conference goers presenting at and attending international
bioethics events. A successful example of this is the Global Forum on Bioethics
and Research. The GFBR has been around for a longish time. It’s funded mostly
by the UK’s Wellcome Trust, the Gates Foundation, the US NIH Fogarty
International Center and the UK’s Medical Research Council. I had a quick look
at the GFBR’s website, with a view to finding out who governs it, and who
decides on the composition of speakers and attendees of its meetings, given
that its funders reside essentially in the USA and the UK. It seems to me as if
the majority of those people are either staff members of these funding
organisations, or are past/current grant recipients.[2]
There appear to be very few truly independent scholars from the global south
among those in charge of organising these
global events.

I don’t think that this is the result of any kind of
malicious intent. It’s likely a function of ‘who do we know who could serve on
that steering committee who is from Africa, Asia etc’, and who does one know?
Well, the answer is likely to be: ‘someone we have funded before’.

However, that alone does not address the question of whether
or not the meetings are failures when it comes to the question of participants
from the global south. Here are the criteria the GBFR uses to determine who
among the applicants will be invited[3]:

·Country
of origin: GFBR would like to ensure a representative distribution of
delegates from different regions;

·Background
/current area of expertise: GFBR is aimed at anyone involved or
interested in health research ethics, including researchers, policy-makers and
community representatives. GFBR seeks representation from many different
disciplines;

·Membership
of an IRB/REC: Membership of an Institutional Review Board / Research Ethics
Committee is not a prerequisite for attending GFBR, but may be taken into
consideration;

·Experience
of ethics: GFBR encourage s a mixture of ‘old’ and ‘new’ faces at each forum
so that participants can productively discuss issues of concern to them and
gain from the perspectives of others. Applicants need not be experts in ethics;

·Reasons
for attending the meeting: GFBR seeks participants who will be able to actively contribute to
the meeting and who expect to impact on research ethics and/or pursue a career
in research ethics in their own country.

While there is the inevitable number of people who
presumably just have to be at every such meeting (let’s call them ‘old’ faces),
the GFBR has succeeded in terms of attracting a fairly wide range of delegates
from the global south to its meetings over the last few years.It’s a small (and expensive) meeting,
designed to host about 80 delegates, but it’s probably a meeting as good as
they come on the global bioethics scene. I truly wish there were more such
events on the global bioethics events’ calendar.

It is fortuitous that the next World Congress of the International Association of Bioethics will be held in New Delhi from 4-7 December 2018 under the theme Health for all in an unequal world:
obligations of global bioethics and is locally hosted by SAMA, the resource
group for women’s health, the Forum for Medical Ethics Society, and, of course,
the IAB.[4]
With a bit of luck (and planning) there might be a plenary dedicated to
figuring out how to enable more delegates from the global south to attend such
events. Why don’t you propose to organise such a plenary to the India- based
hosts of the event. They might consider it quite seriously.